choosing sobriety

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I have been musing about the rates of addiction in doctors. I was taught, many years ago, that doctors had a higher rate of alcoholism and of suicide than the general population.

The BMA estimates one in 15 medics have a problem with drugs or alcohol at some point in their life-time.

Doctors, as a group, are reluctant to face up to their problems, most are good at hiding it. The ever present fear of the regulatory bodies taking away someone’s livelihood is a strong motivator for doctors to keep quiet and not seek help.

Certainly as a medical student there was a culture of excessive drinking, which I saw mirrored in the qualified staff I was working with. Misuse of prescription drugs is common in health professionals, but alcohol is still the most commonly misused substance.(BMA)

Doctors are known to be at least three times as likely to have cirrhosis of the liver than the rest of the population. This is second only to publicans and bar staff.

There are a number of possible reasons for this

Occupational risk factors

Doctors are routinely faced with breaking bad news, and are in frequent contact with illness, anxiety, suffering and death. In day to day practice we deal with many illnesses that cannot be cured, but there are also high expectations from which can put unrealistic pressure on doctors. Aggression from patients is an infrequent, but unpleasant experience. The emotional demands of working with patients can be a major stressor. Do doctors turn to alcohol (most commonly) or other drugs to relieve stress just because it’s very stressful – rather than because innately people with addictive tendencies choose to be doctors?

For junior colleagues, when maybe the patterns and habits of dealing with stress are formed, you can add heavy workload and long working hours with long shifts, weekend working and sleep deprivation. Quite often there is lack of cohesive teamwork and social support, leading junior doctors to work individually (whereas working in teams is associated with being better able to cope with stress). Many of these occupational risk factors are intrinsic to the job.

Individual risk factors

Some studies suggest that the difficult and emotionally demanding job of a doctor frequently leads to doctors being self-critical. The typical personality traits of many medical professionals, such as perfectionism, can lead individuals to become increasingly self-critical which can increase stress and lead to depression. Some practitioners have unhelpful coping strategies (e.g. emotional distancing, rather than actively dealing with stressors) which may add to psychological distress. Other psychological vulnerabilities common in physicians have been identified, including an excessive sense of responsibility, desire to please everyone, guilt for things outside of one’s own control, self-doubt and obsessive compulsive traits.

Mental ill health in doctors cannot simply be due to occupational stressors, as if it were, a much greater percentage of healthcare professionals would be mentally ill. It may be the case that workplace risk factors can lead to mental ill health in vulnerable individuals – in other words, occupational risk factors combine with pre-existing personality factors to create psychological distress.

Alcohol is a ubiquitous tranquilizer, it’s there in every social experience, Do I think I have an alcohol problem because I am a doctor – No. In fact I think during my early career the fact that I worked every third night, and every third weekend probably capped my drinking because I have never drunk before or whilst on duty. Do I think the stresses of my career have added to my tendency to drink excessively? Yes, but I don’t think it’s unique to medicine, I think If I had been a lawyer or a teacher I would have had the same characteristic traits and the same inclination to drink. I think the ‘lack of an off switch’ is inherent – and would be there whatever occupation I had chosen to follow.

If my alcohol dependence is related to my career its in the character traits that make me a good physician, that also lead me to self criticism and being poor at self care – that leave me vulnerable to substance dependence

Much more to read, and much more to ponder on. Just as a last, today we had notification that a patient, aged 44 was found dead at home. He was an alcoholic who failed, despite numerous efforts, (residential rehab included) to quit drinking. When we run an audit of premature deaths in our practice approx 2/3 of all deaths below 65 are drug or alcohol related. Sobering statistics.

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4 comments

Most of those facts and statistics are probably the same for nursing too – I have no research evidence but anecdotally I suspect it is the case. Even those of us who worked with alcoholic liver disease patients went out boozing regularly after a shift and didn’t make the connection between our drinking behaviour and those of our patient group …….

The stats for lawyers are pretty similar. I agree with you – the traits which made me a good lawyer and now good at my new career are one and the same as the things which have made me vulnerable to addiction. I am perfectionist, self critical and need to be in control. Like you, self care is not my strength – it feels selfish to look after myself.

It is so sad about your patient. It really brings things into focus. X

I have heard about doctors. I was a teacher, and I know I would have had a problem no matter what because I had no idea how to stop working so much, to let go of things, and not be so hard on myself.
xo
Wendy